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Metric Driven Strategy for EHR Continuous Improvement
Session #36, February 12, 2019
Brian Kay, Vice President Continuous Improvement
Nicole Klaus, Director EHR Optimization and Strategy
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Brian Kay, MS
Has no real or apparent conflicts of interest to report.
Nicole Klaus, RN, MBA, MPA
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Learning Objectives
About Us
Rogers Improvement System
Managing for Daily Improvement
Application of Agile Methods
Lessons Learned
Agenda
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Identify the strategic benefits of employing daily
and monthly review of EHR performance metrics
in project identification
Evaluate the challenges and opportunities to
overcome them when using data to make
decisions on continuous improvement objectives
• Select metrics that align with the organization’s
vision and strategy
Learning Objectives
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Rogers Behavioral Health:
About Rogers Who We Are
Established in 1907 as Rogers Memorial Hospital,
Wisconsin’s largest private, unaffiliated, not-for-profit
psychiatric and addiction services hospital.
Psychiatrist-driven, evidence-based models of care
by multidisciplinary teams that also include general
medicine physicians, psychologists and other
psychiatric clinicians.
Robust service continuum for the right intensity of
care at the right time:
Inpatient hospitalization
Residential treatment centers
Partial hospitalization (PHP)
Intensive outpatient (IOP)
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Six Rogers Memorial Hospital Wisconsin
locations:
Oconomowoc
Inpatient hospital
8 residential
centers
PHP and IOPs
West Allis
Inpatient hospital
PHPs and IOPs
Brown Deer
Inpatient hospital
PHPs and IOPs
Madison
PHPs and IOPs
Kenosha
PHPs and IOPs
Appleton
PHPs and IOPs
Rogers Behavioral Health:
About Rogers Who We Are
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Regional Rogers Behavioral Health network of specialty clinics
(PHPs and IOPs):
Tampa Bay
Nashville
Chicago
Minneapolis
Philadelphia
St. Paul
San Francisco Bay Area
Miami
San Diego
Rogers Behavioral Health:
About Rogers Who We Are
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Intensive, multimodal treatment in structured
therapeutic settings under supervision of board-
certified psychiatrists.
On-site access to experts in psychiatric
subspecialties and psychology for additional clinical
consultation.
Individualized treatment plans, flexed to
accommodate typical and atypical
fluctuations/shifts in response and comorbidities.
Length of stay calibrated to achieve optimal
therapeutic impact and to sustain and build upon
treatment gains post discharge.
Rogers Behavioral Health:
About Rogers What We Do
Specialized continuums of care:
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Intake
Employee
Experience
Depression
Practice
Management
VSST
EST
TPOC
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Managing for Daily Improvement (MDI) is
focused on transforming to a leadership
culture that:
Creates, accommodates, and sustains a
culture of continuous improvement.
Facilitates a data driven, action oriented,
engaged & empowered lean organization.
Are we having a ‘good’ or ‘bad’ day?
What would ‘better’ not ‘perfection’ look like?
If you have an idea for ‘better’, how would you
implement it? How would sustain it? How
would you improve it?
MDI is about People
What is MDI?
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What is MDI
A series of repeatable processes
designed to…
Connect everyone to what is important
Help leaders at all levels spot normal
from abnormal conditions
Identify and proactively address issues
that impede our success
Develop leaders as coaches
Resolve our “gaps” through team-driven
problem solving and A3’s
Sustain breakthroughs from team
improvements
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Standardized Work - Method
The best known way TODAY
Standard Work will
Sustain the gains
A3 Thinking (PDCA) drives
Continuous Improvement
STD WORK
Performance
Time
STD WORK
Performance
Time
Standard Work is intended to drive change. The more
frequent the change the faster the improvement.
Continually Higher
Performance is an
indication of a healthy
organization
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Tier 1 Readiness Huddle
Key Features:
Safety issues are proactively addressed (focus on preventing harm)
Check Methods, Equipment, Supplies, and Staff’s (MESS) readiness for the day’s work
Understand the day’s work plan / schedule (volume, special needs for patients, etc)
Leader Standard Work:
Front-line leader performs SMESS checks
Leaders perform tiered huddles (unit level to one up) to escalate issues
Higher-level leaders confirm / coach / support performance of these tasks
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Follow standard work
Escalate if SW cannot be
followed
Check MESS
Run Tier 1 huddle
Track and maintain area
performance
Respond to andon and track
abnormalities
Confirm standard work
Do daily PDCA
Run Tier 2 huddle & plan for the day
Monitor unit performance
Perform gemba rounds
Confirm & coach team leads & supv’s
on LSW
Resolve escalated problems
Perform root cause problem solving
Perform gemba rounds and walks
Perform check-act on weekly/monthly
performance
Coach managers on LSW
Lead cross-department problem solving
Ensure that DMS is followed and
improved
Perform gemba walks
Ensure that big issues are resolved
Model coaching and problem solving
Perform gemba walks
Engage leaders in achieving goals
Model coaching and problem solving
Understand and develop capabilities
Team Lead
(Charge
RN)
Managers &
Supervisors
Directors
COO
CEO
Staff
Tiering Communication
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Journey from Reaction to Optimization
Transition from hyrbrid system to system wide electronic system
Grew from a department of 5 to a department of 33
Electronic record development was based on issue management and
tickets
Partnered with Rogers Improvement System to implement MDI
Our Story
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Deciding What to Measure
Project decisions are made based
on potential to have influence on
strategic anchors
Clinical Effectiveness
Patient Experience
Healthy Culture
Responsible Growth
Outreach
Metrics were chosen based on
the impact projects would have on
these actions
Deciding How Often to Measure
Daily
Functional teams huddle daily to
prioritize daily tasks
Bi-Weekly huddles
Leadership council meets weekly
to review project risks and barriers
Monthly
Leadership reviews progress with
executive team to determine
needs
MDI in the Technology World
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Leadership Council
Staff nominated by leadership
Empowered to own meeting and own metrics
Subcommittees
User Experience
Policy and Compliance
Finance
Culture
Scorecard is reviewed and decisions are made
based on problematic areas
Empowering Employees
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Before
Electronic Health Record compliance 82%
Solutions Compliance 71.10%
Medication barcode scanning rate 88%
Service Level Agreement Violations 7.14%
Time in Medical Record 17 min per patient
Nursing time in medical record 5 min per
patient
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Electronic Health Record compliance increased from 82% to 91%
Medication barcode scanning rate increased from an average of
88% to 95%
Service Level Agreement violations decreased to 2.3%
Time in the EMAR per patient for staff decreased from 17.45 to
15.81 minutes
Nursing Partial Hospitalization and Intensive Outpatient level
of care time per patient hit targets for the last three months
due to a targeted implementation
Outcomes Achieved
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Ensuring data accuracy regain confidence from end users in
data
Finding the right data for the right problem finding the best
strategic match
Scheduling and attending the daily huddles adding value to
meetings
Don’t let progress get in the way of perfection start meeting
instead of waiting for the perfect set up
Challenges and Barriers
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Align metrics selected by strategic initiatives. There are so
many metrics to pick from, using the relationship to the vision of
your organization will have more of an impact on your objectives
Set a time limit for daily check ins. Everyone is already busy,
and it becomes too easy to get into the weeds
Leadership should remove barriers identified in huddles right
away to maintain focus
Transfer responsibility of reporting to employees to encourage
engagement and ownership
Tiered reviews - We can target users daily to impact those who
are struggling while making system improvements to enhance
overall use
Recommendations
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Initial Phases
Position based
huddles
Changes driven by
end user feedback
Leadership council
Phase 2 (in progress)
Workstream huddles
Creation of user councils
Partnership with clinical
and revenue leadership
Continued leadership
council (representation
each workstream)
Formal training next week
Next Steps
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Brian Kay
Brian.kay@rogershospital.org
Nicole Klaus
nklaus@rogershospital.org
Please remember to complete the online survey
Questions